Crowdsourcing: TVP

In an effort to demonstrate* the crowdsourcing potential of Twitter for EM medical education resources, I asked:

The crowd performed well and very quickly I got a number of useful responses:

Thanks everybody!

*to a skeptical resident

ACA Update: What do you want?

On June 13, I'm speaking at the Policy Prescriptions Health Policy Symposium at Baylor.

My talk is titled "The ACA: An Evidence-Based Update." To continue my new tradition of crowd-sourcing, what would you want included? What do you know that I should share? What don't you know that you want to?

Keep your ProMISe

The ProMISe study was published in NEJM today -- I'm sure there will be great takes from all around. The first I saw was from Rick Body at St. Emlyn's, very nice summary indeed.

I'll leave the detailed analysis to others. My quick take, mostly based on comparing baseline characteristics of each group (Table 1), interventions in each group (Table 2), and outcomes (Table 3): ProMISe is a lot like ProCESS and ARISE.

The groups were similar, and the outcomes were similar, but most notably, the interventions were similar.

My bottom line interpretation remains the same; the keys in sepsis are:
  • early identification
  • early antibiotics
  • early aggressive resuscitation (particularly fluids)
We've gotten much better at all of those since 2001, which is (in my opinion) the main lesson from Rivers.

What ProCESS, ARISE, and ProMISe really tell us is that if you do all the things that are on a protocol, it doesn't matter whether or not you have a protocol.*

Like with ProCESS, it's a little tricky to decipher what fluids each subgroup actually got. I think Table S7 in the Supplemental Appendix is key:

*more on protocols from me, re: ProCESS

**Correction: just noticed the terminal "e" is not capitalized. Oh well.